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A gone case
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Multiple maxillary anterior implants - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Terry Pannkuk
To: ROOTS
Sent: Tuesday, June 15, 2010 1:44 AM
Subject: [roots] FW: Quiz 2 - More Complicated (if you can believe it)

Hereís the original quiz presentation.  I finally succumbed to doing the endo about a year ago, symptoms didnít
resolve as I feared and I did the surgery a couple of days ago. - Terry

From: Terry Pannkuk
Sent: Tuesday, November 17, 2009 7:32 PM
To: 'ROOTS'
Subject: Quiz 2 - More Complicated (if you can believe it)

Here's another interesting patient I saw today:

5 years ago she had multiple maxillary anterior implants.  When I saw her for consultation I thought she was a
lawn dart victim.  I checked out #7 but findings were equivocal, the tooth tested vital. it was percussion sensitive
but so was #6.  We decided to monitor.  I saw her a year later in 2005, similar symptoms, pulp still vital, but it
wasn't as sensitive as a year earlier.  We decided to continue to monitor.  Here gingival tissues during this period
were inflamed and she was being passed around from periodontist to periodontist and no one wanted to treat her except
the original treating periodontist, but she didn't want to have him treat her (small wonder). She was extremely frustrated.
By 2007 she found a periodontist who did some grafting, her dentist placed some provisionals and she looked a lot better......
only one problem she developed a fistula that traced to the #9 implant.  With all the goofing around with the #9 implant.
the internal threads had been stripped, the cover screw was presumed loose and the consensus opinion was that the internal
implant space was communicating and contaminated.  Some suggested that I do an apico on it (only upside down and place MTA
in the screw hole space and "put it to sleep".  It wasn't part of the restorative plan because of esthetics.  An implant
supported bridge was the new final restorative plan.  I didn't think it would be a good thing to do and suggested that
the new periodontist trephine it out and graft the area.  The compromise plan was for the periodontist to do the surgery
and drill the coronal part of the implant down deeper eliminating the space area.  I thought that was a good plan and
it was done.  A year later the area had healed, but her biting discomfort and sensitivity was isolated to #7.  I finally
decided to treat it a year ago to rule out endo.  Of course she still has the same pain one year later. She had another
graft performed about 3 months ago.  Tooth #7 is moderately percussion sensitive with normal probing depths.

This woman is tired of being sliced and diced. Check out all the attached chronologic photos and radiographs.  Clearly the
implant in the #8 site is probably close to the apex of #7. What would you do?  - Terry

Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Radioluscency
Lateral incisor
Obturation
Churning irrigant
Cold lateral
Tipped to lingual
Acute pulpitis images

Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
Acute apical abcess
Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves

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